Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children.
Computer EF games improve inhibition only in autistic children who also show ADHD traits.
01Research in Context
What this study did
Rieth et al. (2022) ran a computer game program that trains executive function. Kids with autism played adaptive games that target inhibition, working memory, and shifting. The team also recorded brain waves before and after to see if training changed neural signals.
They split the children into two groups. One group played the games for several weeks. The other group waited. Then they compared scores on EF tasks and autism symptoms.
What they found
Only the autistic kids with strong ADHD traits got better at inhibition. The rest showed no EF gains. A special brain wave change predicted fewer repetitive behaviors later. The games did not help every child with autism.
In short, the training works only for a slice of the autism spectrum — those who also act hyper or inattentive.
How this fits with other research
de Vries et al. (2018) tested the same game suite four years earlier. They saw tiny benefits and said kids with fewer autism traits gain more. R et al. now refine that message: ADHD features, not autism severity, decide who wins.
Fisher et al. (2005) found no EF gain after brief training. R et al. show longer, game-based practice can move inhibition, but only in the ADHD-like subgroup. The field has moved from 'EF training fails' to 'EF training helps if you pick the right kids.'
Klein et al. (2024) also blended autism and ADHD kids. Eye-tracking training boosted working memory for the whole mix. R et al. untangle the knot: the benefit is driven by the ADHD part of the blend.
Why it matters
Before you assign computer EF games, screen for ADHD traits. Use parent checklists like the Conners. If scores are high, add the games to your plan and track inhibition on a go/no-go task. If scores are low, spend your hours on skills that have stronger evidence for that child.
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02At a glance
03Original abstract
Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co-occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7- to 11-year-old autistic children, we explored: (1) whether co-occurring attention-deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, "For whom is training effective?" We also explored: (2) the extent to which changes in a brain-based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, "How is training effective?" We found that EF training improved behavioral inhibition only for children with clinically significant co-occurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre-to-post change in an EEG-based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior. LAY SUMMARY: Understanding both for whom and how interventions work will help us provide personalized care to children with autism spectrum disorder (ASD). Autistic children present with many different strengths and challenges. Co-occurring mental health challenges may affect how much autistic children benefit from intervention. We analyzed secondary data from a rigorously designed pilot intervention study, a randomized control trial (RCT), that enrolled 70 7- to 11-year-old autistic children to assess whether a set of computer-based executive function (EF) training games improved their performance. Executive functions include being able to shift between tasks, inhibit a response, and keep information in working memory. In the current study, we explored: (1) whether children's co-occurring attention-deficit/hyperactivity disorder (ADHD) features or anxiety features, measured before the EF training began, affected how much they benefited from the EF training. In other words, we asked, "For whom is training effective?" We also explored: (2) whether children's brain-based changes in EF predicted their performance in everyday life (e.g., parent report on a survey). This is a step toward asking, "How is training effective?" We found that EF training improved children's inhibition ability, but only for children with clinically significant ADHD features. While many children in our sample also had anxiety features, we found that anxiety levels did not affect how well the EF training worked. Finally, for children who received the EF training, changes in a brain-based measure of conflict monitoring (i.e., being able to noticing differences in stimuli) predicted changes in children's repetitive behaviors. This study provides early evidence that EF training may be more effective for some autistic children than others, especially those with ADHD features.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1007/s10803-018-3856-7